应用频域心率变异性分析定量评估西苯唑啉治疗迷走神经性阵发性心房颤动。

Quantitative assessment of cibenzoline administration for vagally mediated paroxysmal atrial fibrillation using frequency-domain heart rate variability analysis.

机构信息

Second Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.

出版信息

J Cardiol. 2009 Aug;54(1):86-92. doi: 10.1016/j.jjcc.2009.04.009. Epub 2009 May 27.

DOI:10.1016/j.jjcc.2009.04.009

PMID:19632526

Abstract

BACKGROUND

Cibenzoline (CBZ), a class I antiarrhythmic drug, has been widely used to maintain sinus rhythm in patients with paroxysmal atrial fibrillation (P-AF). This agent has an anticholinergic action and will become the drug of first choice for vagally mediated P-AF. We assessed its efficacy quantitatively by analyzing the frequency-domain heart rate variability (FD-HRV) of the Holter electrocardiogram (ECG) in patients with vagal P-AF.

METHODS

We enrolled 65 consecutive patients with vagal P-AF, but 31 patients were excluded because of the occurrence of significant arrhythmias during the 24-h Holter recordings. Accordingly, CBZ was administered to the remaining 34 patients. After administration, a Holter ECG recording was made again. High frequency (HF) components, i.e., vagal tone index, on the FD-HRV analysis from 00:00 h to 06:00 h were used for assessment. In 14 patients, the treatment was changed to disopyramide (DSP) and the same analyses were performed.

RESULTS

In two patients, the FD-HRV analysis was not utilized after administration. Finally, 32 patients were available for evaluation. CBZ was considered effective for vagal P-AF in 24 patients (75%). After administration, the HF component levels decreased (1589+/-795 ms(2) vs. 850+/-524 ms(2), p<0.0001). Comparison of the pre-administration HF component levels between the CBZ-responsive group and the CBZ-non-responsive group showed higher levels in the CBZ-responsive group (1766+/-758 ms(2) vs. 1058+/-690 ms(2), p=0.026). Although no significant difference in the reduction of the HF component levels was found between CBZ and DSP, DSP had anticholinergic side effects in two patients (14%).

CONCLUSIONS

In vagal P-AF patients, larger HF components on the FD-HRV analysis could be a hallmark of the antiarrhythmic action of CBZ. The reduction in the HF component levels after drug administration is useful for a quantitative assessment of anticholinergic action.

摘要

背景

西苯唑啉（CBZ）是一种 I 类抗心律失常药物，已广泛用于维持阵发性心房颤动（P-AF）患者的窦性节律。该药物具有抗胆碱能作用，将成为迷走介导的 P-AF 的首选药物。我们通过分析迷走性 P-AF 患者动态心电图（ECG）的频域心率变异性（FD-HRV）来定量评估其疗效。

方法

我们纳入了 65 例连续的迷走性 P-AF 患者，但由于 24 小时 Holter 记录期间发生明显心律失常，31 例患者被排除在外。因此，对其余 34 例患者给予 CBZ 治疗。给药后再次进行 Holter ECG 记录。使用 FD-HRV 分析从 00:00 h 到 06:00 h 的高频（HF）成分，即迷走神经张力指数进行评估。在 14 例患者中，将治疗改为双异丙吡胺（DSP），并进行相同的分析。

结果

在两名患者中，给药后未进行 FD-HRV 分析。最终，32 例患者可进行评估。24 例（75%）患者认为 CBZ 对迷走性 P-AF 有效。给药后，HF 成分水平降低（1589+/-795 ms(2) 比 850+/-524 ms(2)，p<0.0001）。比较 CBZ 反应组和 CBZ 非反应组给药前 HF 成分水平，CBZ 反应组水平较高（1766+/-758 ms(2) 比 1058+/-690 ms(2)，p=0.026）。虽然 CBZ 和 DSP 组 HF 成分水平降低无显著差异，但 DSP 在 2 例患者中出现抗胆碱能副作用（14%）。